Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

Chapter 4 

Reaching Specific 

Populations 

[Cultural] competence is not just changing how somebody 

looks in an ad or the language. It’s about understanding 

people as whole entities: their history, their culture, their 

context, and their geography. 

— Robert Robinson, Office on Smoking and Health 

Centers for Disease Control and Prevention 

In This Chapter
 

• Developing Cultural 

Competence 

• Identifying and 

Describing Specific 

Populations 

• Conducting 

Formative Research 

Although the main emphasis of your tobacco counter-marketing campaign 

may be on one or more broad target audiences, you may also want to conduct efforts that focus on specific populations—groups of individuals who 

share unique characteristics and may be particularly affected by tobacco. 

These shared characteristics include racial, ethnic, cultural, geographic, age, 

physical, and socioeconomic traits, and level of education. Examples of 

specific populations include: 

■ Racial/ethnic minority groups 

■ Gay, lesbian, bisexual, and transgender populations 

■ Rural residents 

■ Groups with low socioeconomic status 

■ People with disabilities 

■ College students 

■ Restaurant workers 

■ Blue-collar workers 

• Additional 

Considerations in 

Reaching Specific 

Populations 

Chapter 4: Reaching Specific Populations 87 
Developing and implementing successful 

counter-marketing strategies to reach these 

populations may be challenging. Although 

you’ll follow the same basic processes used to 

design any counter-marketing campaign, 

reaching specific populations requires additional approaches and considerations. For 

example, you may need to take a closer look at 

your organization’s operating practices to 

ensure that they are inclusive, culturally 

competent, and adequately address the needs 

of the specific populations in your state. You 

will also need to develop an understanding of 

the specific populations you plan to target to 

ensure that messages, language, imagery, and 

other aspects of your counter-marketing 

materials and interventions are appropriate 

and effective. 

It is important to devote adequate resources to 

reaching the specific populations in your state. 

When appropriate, it can be cost-effective to 

design your specific population campaign to 

supplement your mainstream effort. Creating 

messages that are coordinated with your mainstream campaign can help provide specific 

populations with the multiple exposures 

needed to contribute to attitude and behavior 

change, as well as to build support in populations for tobacco control policies. 

If your budget won’t permit you to reach all 

audiences at once, you’ll need to decide which 

audiences you can reach with your current 

funding, and which audiences you’ll want to 

target if your funding increases. Lack of information may also constrain the breadth of your 

efforts and may require that some population 

groups not be included initially. 

Developing Cultural Competence 

When developing a counter-marketing effort 

for a specific population, the first step is to 

look at your organization’s level of cultural 

competency. The main goal of building an 

organization’s cultural competence is to be 

more effective in representing and serving its 

constituents by developing strategies and 

programs that reflect the needs and priorities 

of those served. An organizational and 

philosophical commitment to diversity and 

inclusivity provides the basis for achieving 

cultural competence. In essence, it reflects the 

commitment to understanding specific 

populations and taking actions to serve them. 

Developers of tobacco counter-marketing 

programs need to recognize the differences 

and similarities within and among groups, 

including how they are influenced by their 

particular cultures, histories, the prevailing 

social and economic contexts, and the geographies in which they live. Developing cultural 

competence may require your organization to 

assess its physical environment, materials and 

resources, policies and procedures, training, 

and professional development. 

Developing cultural competence may also 

require your staff and anyone else who works 

on your program to reflect on their own values 

and attitudes, communication style, and which 

community or audience they are representing, 

so that they are prepared to relate to diverse 

populations and to be responsive during 

interactions with them. Even if an organization 

has individuals from a specific population on 

its staff, cultural competence may still need to 

be addressed. Because each person has 

88 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

different biases and experiences, it’s important 

for every staff member to recognize the value 

of being culturally competent. 

Developing cultural competence within your 

organization should enable you to work more 

effectively with the communication agencies 

that you have hired to focus on the specific 

population(s) you are targeting. This will help 

ensure the development of culturally competent messages and materials. 

Cultural competence goes beyond recognizing 

and incorporating the language of target 

audiences in your programs. For example, to 

make a tobacco cessation counseling program 

culturally competent, the program manager 

may need to: 

■	 Develop an organizational commitment 

to cultural competence 

■	 Employ counselors who speak languages other than English 

■	 Develop and pretest, with each subpopulation, concepts and materials that 

reflect issues related to smoking in the 

community 

■	 Develop and pretest materials in appropriate languages for specific communities 

■	 Include community representatives on 

planning committees 

■	 Train staff to be sensitive to cultural 

issues when providing tobacco 

cessation counseling 

Chapter 4: Reaching Specific Populations 89 
■	 Hold staff accountable for the way they 

interact with counseling program clients 

■ Training 

■	 Visionary leadership 

Wisconsin’s Division of Public Health provides 

an example of how cultural competence can 

be developed and promoted (National Center 

for Cultural Competence 1999). Its staff formulated guiding principles and strategies to 

promote cultural competence in the design of 

health programs, including the following: 

■	 Audits of an organization’s existing 

culture	 

■	 Clarification of the mission of diversity 

enhancement 

■	 Strategic goals 

■	 Examination of assumptions dealing 

with cultural competence 

The National Center for Cultural Competence, 

at Georgetown University Center for Child 

and Human Development, offers several 

helpful self-assessment tools that you can 

adapt and use to gauge cultural competence 

within your own organization. These checklists 

are available online at www.georgetown.edu/ 

research/gucdc/nccc/products.html. You may 

want to consider hiring a consultant to help 

your organization become as culturally 

competent as possible or to assess your 

organization’s cultural competence. You may 

even want to add a diversity specialist to your 

staff to help increase the staff’s cultural 

competence. 

Checklist for Developing Cultural Competence in an Organization 

❑	 Reflect an organizational commitment to developing cultural competence in all of the 

organization’s policies, procedures, physical environments, programs, and activities. 

❑	 Promote cultural competence among your staff as a developmental process though an 

ongoing organizational commitment to self-assessment, professional development, 

training, policy development, and implementation. This process will help your 

organization build the capacity to understand and meet the needs of the specific 

population(s) it serves. 

❑	 Encourage key staff to conduct cultural self-assessments. (Sample tools are available 

from the Wisconsin Division of Public Health and the Georgetown University Center 

for Child and Human Development). 

❑	 Don’t make assumptions about a population’s culture. Become knowledgeable 

regarding aspects of the specific populations (e.g., values, attitudes, communication 

styles, language, literacy levels, physical environments, histories, cultures, social and 

economic contexts, and geographies) served by your organization. 

90 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

Identifying and Describing Specific 

Populations 

Identifying and Prioritizing Specific 

Populations in Your State 

Specific populations traditionally have been 

defined by demographic characteristics such as 

age, race/ethnicity, income, and educational 

level. However, you may need to go beyond 

basic demographics to adequately describe the 

specific populations in your state. Specific 

populations will also be shaped by history, 

culture, context, and geography—factors that 

are only partially reflected in the sociodemographic descriptors and that can affect attitudes and preferences. Group identity can also 

be reinforced by particular experiences with 

educational institutions, religions, government, businesses, and other institutions. 

Identifying different specific populations is 

further complicated by the diversity within 

respective populations. For example, the 

broader category of Hispanics/Latinos can be 

further delineated into subgroups such as 

Cubans, Mexicans, and Puerto Ricans, each 

with its unique characteristics. Similarly, the 

gay, lesbian, bisexual, and transgender (GLBT) 

community is composed of subgroups with 

very different characteristics. Making this issue 

even more complex is the overlap among 

groups made up of individuals who share some 

characteristics but also identify with other 

populations as well. For example, people with 

disabilities, members of the GLBT community, 

and restaurant workers who are exposed to 

secondhand smoke at work may also identify 

with specific racial or ethnic groups. 

The first task in selecting and prioritizing 

specific populations that your tobacco 

counter-marketing efforts will target is to 

identify and describe each group affected by 

tobacco use in your state. Sources that might 

help you identify these groups include U.S. 

Census Bureau data, public health department 

reports, public school data, media outlets, 

national organizations, immigrant assistance 

or resettlement programs, and language 

institutes, which may show trends in demand 

for translators or interpreters. Although these 

sources can help you determine the representation of various populations in your state, 

they also have limitations. For example, they 

may underestimate the size of specific groups 

(e.g., Cambodians within the Asian/Pacific 

Islander community). These sources may also 

fail to identify certain groups if the appropriate 

questions are not asked (e.g., sexual identity 

questions to identify GLBTs). Depending on 

the quantity, quality, and types of data available from existing sources, you may need to 

conduct new research to gain enough information about the specific populations in your 

state or community to make well-informed 

decisions. 

In determining which specific populations 

should be priority audiences for your countermarketing efforts, you’ll also need to study 

epidemiologic data, media consumption 

patterns, and other available qualitative data 

to assess whether counter-marketing is an 

effective intervention for a particular group. 

Some population groups can’t be reached 

efficiently through mass media or other 

traditional counter-marketing techniques, 

Chapter 4: Reaching Specific Populations 91 
so you may want to use other program 

components to reach those groups. 

Understanding Your Priority Audiences 

Once you have chosen a specific population 

group as a target audience, you must learn about 

the characteristics shared by individuals in that 

group. For many populations, this means 

understanding such factors as their culture. 

Culture has been defined as “the shared values, 

traditions, norms, customs, arts, history, folklore, 

and institutions of a group of people unified by 

race, ethnicity, language, nationality, or religion.” 

Culture affects how people pattern their 

behavior, see the world around them, and 

structure their environment, especially their 

families and communities (USDHHS 1996). 

However, culture provides only one window 

into a community. Your tobacco countermarketing strategies should also take into 

account and reflect other factors that drive 

any community. Geography is another way to 

understand how communities are differentiated. For example, African Americans who live in 

large urban areas will likely have different 

characteristics than African Americans who 

live in rural tobacco-growing communities, 

where tobacco is an important part of the 

economic and cultural fabric. Age, gender, and 

sexual orientation are other factors that impact 

the attitudes and behaviors of the group being 

targeted. 

While there is heterogeneity within any group, 

it is important to understand that there are still 

likely to be common elements that bring these 

groups together as a broader community. It is 

these commonalities that allow countermarketing programs to target such groups 

efficiently. 

Defining Specific Populations and 

Targeted Segments 

The challenge is to describe your target audience using the most relevant, unbiased, and 

data-driven characteristics possible, as well as 

information based on how the group describes 

itself and how others describe it. Formative 

research may reveal characteristics that 

provide a more accurate and appropriate 

description of the target group. Including more 

detail in the description of an audience may 

uncover information useful for your countermarketing efforts. A more detailed audience 

profile may include media or consumer habits, 

lifestyle characteristics, level of acculturation, 

region, or place of residence (e.g., urban or 

rural). 

92 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

You’ll also want to gain an understanding of 

the social context of your audience by examining the social influences that may affect 

behavior. For example, determining the roles 

that family members and friends play within a 

specific population and identifying other 

supporters, such as those from whom a 

population’s members seek advice, are parts of 

defining a population’s social context. This 

kind of information can yield valuable insights 

into your target audience, how they interact 

with others, and how they interact with and 

are influenced by tobacco. Other contextual 

factors that may impact campaign development are the proportion of people of low 

socioeconomic status, the availability of 

cessation services, and the relevance of 

tobacco use relative to other problems 

confronting the target audience. 

You can also target your marketing efforts 

more precisely if you consider subgroups 

within major populations. For example, recent 

immigrants may smoke less than members of 

their population who have lived in the United 

States longer and who have been exposed to 

higher levels of tobacco industry marketing. In 

addition, these two subgroups may consume 

different kinds or amounts of media. If you are 

focusing on a population with such subgroups, 

then you may want to reach recent immigrants 

(who have lower prevalence) with a prevention 

message and those who are more assimilated 

(who have higher prevalence) with a cessation 

message. There may be differences among 

people from the same major group based on 

the country of origin. For example, Asian 

Americans who come from China, Japan, 

Korea, Vietnam, or another country may have 

very different characteristics, attitudes, and 

behaviors. There also may be differences 

among people from the same country based 

on the region of origin. These differences can 

be understood through an assessment of 

particular histories, cultures, contexts, and 

geographies. You’ll need to consider these 

differences when deciding what messages, 

tone, channels, activities, and other factors 

would be most appropriate for specific populations in your community or state. For 

example, some ads work well among all 

Hispanic/Latino groups, while others communicate effectively to only a few groups, 

based on the particular accents, vocabulary, 

and other ad elements chosen to reflect 

particular groups’ lifestyles. 

When your target audience has many different 

segments, testing messages and materials is 

critical to assess different potential responses 

among the different segments. Test messages 

with representatives of the target audience and 

other stakeholders to be sure they are understood and accepted and to avoid possible 

unintended negative effects. (See Chapter 3: 

Gaining and Using Target Audience Insights for 

more information on testing methods.) When 

evaluating messages, don’t rely on the 

opinions of your organization’s staff. Even if 

they are members of the target audience, 

they’re likely to have a knowledge base about 

tobacco and public health that makes them 

atypical of the audience as a whole. 

Chapter 4: Reaching Specific Populations 93 
Checklist for Identifying and Defining Specific Populations 

❑	 Identify and describe the specific populations that are affected by tobacco use in your state. 

❑	 Assess whether counter-marketing is an effective intervention for the groups you have identified. 

❑	 Define your target group using demographics, epidemiologic data, consumer habits, lifestyle data, 

and other sources of information. 

❑	 Recognize the diversity among certain specific populations, as well as among their subpopulations. 

❑	 Pay close attention to the level of acculturation among immigrant groups, because the characteristics, attitudes, behaviors, and responses of recent immigrants may be very different from those of 

immigrants who have lived in the United States for several years. 

❑	 Make attempts to understand the tobacco-related social norms among the specific populations your 

program is targeting. 

Conducting Formative Research 

Findings from formative research can be 

used to help develop, or “form,” a countermarketing program. Formative research may 

consist of several parts, including environmental profiles, inventories of community 

resources, and audience research. As 

mentioned earlier in this chapter, formative 

research can help you understand how to 

separate the population into groups or 

segments that tend to think or act in similar 

ways or are affected by similar influences. It 

can also help you to understand the causes, or 

determinants, of tobacco use and other health 

risk behaviors, and the protective factors in 

target audiences. This research is also used to 

investigate which interventions might 

influence target audiences to change their 

behavior(s). (See Chapter 3: Gaining and 

Using Target Audience Insights for detailed 

information on research.) 

Conducting an Environmental Scan 

When you begin the research process, it can be 

extremely helpful to look at whether existing 

tobacco counter-marketing programs have 

been successful in helping to reduce tobacco 

use among the specific populations you’ve 

chosen to target. Look at programs that other 

organizations have implemented in your state, 

as well as those implemented by other states. 

Contact your representative in the Office on 

Smoking and Health, Centers for Disease 

Control and Prevention for information 

compiled from state efforts. Or, if you want 

information about a specific state’s program, 

you can contact individuals or search Web sites 

within that state. If components of another 

state’s programs appear applicable to your state, 

test those components—including ads and 

other materials—in your state before you 

implement them to confirm that they are likely 

to work in your area with your specific 

94 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

population. One excellent resource for 

accessing and using tobacco counteradvertising produced by states, organizations, 

and federal agencies is CDC’s Media Campaign 

Resource Center, available online at 

http://www.cdc.gov/tobacco/mcrc. 

You will also want to learn about organizations 

and individuals working with various specific 

populations who might be able to serve as 

resources to help you develop the campaign. 

Investigate which of these resources have the 

strongest expertise in developing programs, 

interventions, and materials for the specific 

populations you’re targeting. Some of these 

organizations and individuals may be key 

stakeholders for your program. (See Chapter 8: 

Public Relations for more information on 

stakeholders.) Your public relations efforts will 

also include identifying media outlets that 

target your specific audiences. You need to 

work with these media outlets for your paid 

media placements and earned media 

coverage. 

Applying Research Results to 

Campaign Development 

To help ensure that your campaign reaches the 

specific populations you plan to target, you 

will want to follow the same guidance and 

processes used for general market campaigns 

outlined in this manual. (See Chapter 2: 

Planning Your Counter-Marketing Program, 

Chapter 3: Gaining and Using Target Audience 

Insights, Chapter 7: Advertising, Chapter 8: 

Public Relations, Chapter 9: Media Advocacy, 

Chapter 10: Grassroots Marketing, and 

Chapter 11: Media Literacy.) You’ll also want to 

develop and implement an evaluation plan 

that includes evaluation of the efforts targeting 

specific populations. (See Chapter 5: 

Evaluating the Success of Your CounterMarketing Program.) 

Findings from qualitative research can be used 

to strategically develop materials that will 

reach the target audience with the intended 

messages. Through qualitative research, you 

can glean insights about your audience(s), 

solicit feedback on the materials and messages 

you are developing, and brainstorm about 

additional interventions that appeal to them. 

These findings can help you in making 

decisions throughout the campaign development process about aspects of the campaign, 

such as strategies, messages, tactics, and 

materials. (See Chapter 2: Planning Your 

Counter-Marketing Program for a more 

complete discussion of campaign planning 

steps.) It is important to remember that the 

findings from qualitative formative research 

techniques (e.g., focus groups) cannot be 

generalized to the population as a whole, but 

quantitative research techniques can provide 

findings that can be generalized to the entire 

group (see Chapter 3: Gaining and Using 

Target Audience Insights). 

The first step is to set an overall program goal 

and select which specific populations you will 

target. For example, your overall program goal 

might be to increase cessation among adults, 

and you may have decided to supplement 

your general market cessation campaign with 

a campaign specifically targeting Hispanic/ 

Latino men to persuade them to try to quit 

Chapter 4: Reaching Specific Populations 95 
smoking. To accomplish your goal, you will 

need to develop strategies for communicating 

with your target audience(s). If your formative 

research reveals that smoking is supported by 

the cultural values of this audience, you might 

develop a strategy to communicate the cultural 

value of family well-being and the harm of 

secondhand smoke to family members. This 

strategy might be used to help counter the 

values that support smoking. Another strategy 

might be to show the benefits that audience 

members are likely to enjoy when they quit 

smoking or the negative consequences they 

might suffer if they continue to smoke. 

to communicate to your target audience. For 

example, your messages to a Hispanic/Latino 

adult male smoker may include how much his 

family would suffer if he were to become ill or 

die from smoking, how much he would suffer 

physically and emotionally from the consequences of smoking, or how ill his children 

might become from being exposed to his 

second-hand smoke. These messages should 

be developed based on the findings of your 

formative research. 

The next step is to develop specific messages, 

which are the two or three key points you want 

You’ll want to develop specific tactics and 

activities to use in implementing your strategies. If your environmental scan identified 

qualified organizations and individuals in your 

state or community who work with the specific 

population(s) you have chosen, 

they may be able to provide 

valuable input to the 

development of tactics and 

activities based on their 

experiences and expertise. For 

example, one tactic would be to 

have people share their experiences of being harmed by 

smoking. Such stories can be 

effective because they personalize the risk of smoking. You 

could work with hospitals or 

Hispanic/Latino health 

organizations to identify and 

interview affected individuals 

and select the most powerful 

stories. This approach was used 

in a smoking cessation 

campaign in Massachusetts that 

featured a Hispanic/Latino man 

96 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

who developed emphysema early in his life 

from smoking. He eventually lost his voice and 

had to speak through an artificial-voice device. 

The Massachusetts Tobacco Control Program 

developed this story into poignant television 

and radio ads. 

Review all your options for use of paid media 

to reach your audience(s), and choose ones 

that are cost-effective. In addition to broadcast 

and print media, your campaign could include 

billboard ads, postcards that people could send 

to loved ones encouraging them to quit smoking, and signs on public transit vehicles. You 

could also develop posters for places where 

people tend to meet, such as community centers. 

As part of your earned media outreach efforts, 

you could contact reporters at the Hispanic/ 

Latino media outlets you have identified and 

pitch a story about the consequences of an 

individual’s smoking. You can put reporters in 

touch with the individuals featured in your ads 

as a way to weave your messages into a personal 

story. 

You may want to hold a kickoff event to introduce your campaign, inviting people from 

your specific population, organizations that 

represent them, and the media. Use such an 

event as an opportunity to highlight your 

program and to give credit publicly to local individuals who helped to develop the program. 

Once the campaign has started, you can begin 

to measure its effect. Using the same measures 

and indicators you used to conduct baseline 

research before the campaign started, conduct 

follow-up research after the first phase of the 

campaign and after the campaign ends. This 

evaluation will enable you to identify what 

worked, what progress was made, and what 

changes need to be made for additional 

campaign phases. (See Chapter 5: Evaluating 

the Success of Your Counter-Marketing 

Program for more information.) As with any 

counter-marketing campaign, developing 

campaigns to reach specific populations is an 

evolutionary process; you’ll learn what works 

and what doesn’t work as you go along, and 

you will make adjustments as necessary. 

Involving Specific Populations in 

Research 

Representatives of the targeted audience(s) 

should participate in the research to increase 

their ownership of, comfort with, level of 

support for, and the face validity of the 

counter-marketing efforts. It’s important to 

enlist cooperation from community organizations that represent these populations. 

Because they are familiar with the community, 

they may be able to help you select contractors 

and facilitators who have the right skills and 

expertise to work with your target audience(s). 

You may even be able to identify and train 

local people to conduct the research. These 

members of the community—possibly social 

workers, community workers, religious and 

peer leaders, and health professionals— 

understand the community from the inside 

and have established trust with other 

community members. Thus, they may be able 

to probe more deeply into the attitudes, 

behaviors, and practices of the specific 

population you’re trying to reach, and to elicit 

information that can more effectively guide 

campaign development. However, you may 

Chapter 4: Reaching Specific Populations 97 
Checklist for Conducting Formative Research 

❑	 Choose qualified researchers who understand cultural competence. 

❑	 Involve specific populations at every phase of the formative research. 

❑	 Research specific populations’ responses to the tones of different messages. 

❑	 Address concerns and fears expressed by the specific populations and identified in 

scientific literature. 

❑	 Share findings with the organizations that represent specific populations to keep 

them updated on the development of the campaign. 

❑	 Use research findings to help encourage specific populations to support the resulting 

strategies and activities of the counter-marketing program. 

❑	 Use research findings to help guide decisions during the development 
 

of the campaign.
 

run the risk of focus group participants not 

feeling safe with a moderator they know 

because of issues of confidentiality and 

disclosure of personal information. In addition, you must be confident that these 

members of the community are qualified to 

conduct the research. Although the process to 

train and develop a set of skilled moderators 

for specific populations may be time consuming, you may find that the audience 

insights you gain are a valuable long-term investment in making your campaign a success. 

When conducting qualitative research, you 

should pay close attention to ties to the tobacco 

industry or other potential conflicts of interest 

that could serve to bias results of the research. 

You may need to make a special effort to 

address concerns that communities may have 

about research. These concerns could be 

based on negative historical experiences such 

as the Tuskegee Study, a research project in 

Chapter 4: Reaching Specific Populations 

which treatment was secretly withheld from 

African-American men with syphilis. Or they 

could be based on the belief that the community has been overly researched and 

exploited by scientists more interested in 

publishing papers than in solving problems. 

Efforts may include dispelling fears, promoting 

involvement in the formative research at every 

stage, and obtaining input about how the data 

will be used. These efforts can help considerably to raise trust and maintain a sense of 

ownership of the research and its products. 

Additional Considerations in 

Reaching Specific Populations 

When developing and implementing a campaign for a specific population, you should pay 

close attention to the following areas: 

■ 	 Involving the target population in the 

development process 

98 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

■	 Using appropriate language and images 

in materials development 

■	 Identifying and addressing potential 

barriers arising from concerns of the 

target audience (audience barriers) 

Involving the Specific Populations in 

the Development Process 

Tobacco counter-marketing programs should 

include the target audience’s participation 

throughout the life of the program. This 

representation ensures that programs reflect 

the specific population’s values, norms, 

behaviors, perspectives, and needs. 

Each planning phase should include developing relationships and partnerships with specific 

populations and persons and groups that 

serve or have access to them. These may 

include professional and fraternal organizations; African-American, Asian, Hispanic/ 

Latino, or American Indian/Alaska Native 

chambers of commerce; or professional media 

organizations, such as publishers of minority 

newspapers or magazines. 

Give all partners the opportunity to declare 

conflicts of interest early in the planning 

process. Tobacco companies have a great deal 

of influence in most communities and with 

the media, including communities and media 

of specific population groups. Some ethnic 

media outlets receive substantial revenue from 

the tobacco industry and thus may not be 

suitable partners for developing antitobacco 

media strategies. Although your state may not 

want to partner with those outlets, you’ll 

probably want to place antitobacco ads in the 

same outlets to counter the protobacco 

messages. In addition, because some media 

outlets in communities of color have depended 

on revenue from tobacco industry advertising, 

it may be strategically important to acknowledge this history when defining your relationship with those outlets. A flexible approach in 

the short term may make you more likely to 

achieve your long-term goals. 

Checklist for Involving Specific Populations in the Development 

Process 

❑	 Assess your agency’s cultural competence to avoid any bias in choosing partners. 

❑	 Include representatives of the specific population in all phases of the program, from 


formative research and planning through implementation and evaluation. 


❑	 Select people or groups that represent the specific population’s diversity and
 

perspectives and that are credible with the target audience.
 

❑	 Include representatives who have access to large numbers of specific population 


members, such as media outlets (e.g., radio, TV, and magazines) and organizations 


(e.g., racial/ethnic, professional, religious, schools). 


Chapter 4: Reaching Specific Populations 99 
100 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

One way to gain target audiences’ support for 

your program is to help them recognize how 

tobacco use harms their community and how 

they can help address the problem. For example, sharing with the GLBT community 

information about disproportionate rates of 

tobacco-related morbidity and mortality in 

their community may help members become 

more interested in the issue. Then, facilitating 

a discussion with GLBT leaders in which 

tobacco industry targeting of their community 

is highlighted may motivate them to take 

action against these marketing practices. 

When sharing information with members of 

a specific population, it is important to cite 

sources that are credible and relevant to that 

audience. These sources may be members 

of the specific population. 

Using Appropriate Language and 

Imagery in Materials Development 

Ideally, you should develop messages and 

materials in the language of your target 

audience from the start. Try to involve native 

speakers of the language to write and review 

the text, design, graphics, and images. When 

the language is not English, you may also want 

to conduct a reverse translation, in which you 

translate the foreign-language document into 

English. This serves as a quality control 

measure to ensure that the key messages and 

concepts will be communicated as intended. 

If you cannot develop language-specific and 

culturally appropriate materials and instead 

must start with the original (often English) 

version, don’t rely on a direct translation of a 

message. Always test the translation first. When 

the text is finalized, it’s often helpful to have a 

second translator conduct a reverse translation. 

You should check references on translators to 

determine whether they have met the needs of 

previous clients. The following example 

illustrates the steps in addressing language 

differences: 

In 1997, the CDC Prevention Marketing 

Initiative Nashville Demonstration Site 

developed an English-language radio soap 

opera as a mass media intervention to reach 

African-American teens with messages on 

prevention of HIV (human immunodeficiency 

virus) and sexually transmitted diseases. When 

the intervention was replicated to reach 

Spanish-speaking teens, focus groups and 

three translations of the script were needed to 

make the intervention appropriate for teens 

from the various Hispanic/Latino cultures of 

Central America, Mexico, Puerto Rico, and 

South America. 

The first translation was completed by the 

Tennessee Foreign Language Institute, the 

second by a committee from the local 

Spanish-speaking community, and the third by 

a group of Hispanic/Latino teens who adapted 

the script to accommodate teen culture and 

language within the Hispanic/Latino community (CDC 1997). The final product was a 

consensus script that incorporated all three 

translations. One critical aspect of the 

translation was the presence of the Hispanic/ 

Latino teens during the final translation and 

during the production of the soap opera. Their 

Chapter 4: Reaching Specific Populations 101 
102 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

Checklist for Developing Appropriate Materials 

❑	 Use language and images that are sensitive and appropriate. 

❑	 Use native speakers to create foreign-language materials when possible. 

❑	 Ask for and check references to ensure that your translator’s past work met client 

needs. 

❑	 Pretest all materials to ensure that messages and images are clear, that content is 

appropriate, and that language and images are not offensive to the target group or 

its community. 

❑	 Conduct a reverse translation to ensure that messages and key concepts are
 

communicated accurately.
 

attendance prevented grammatical errors and 

ensured that a correct script was followed for 

each episode of the soap opera. Each step in 

the replication process ultimately contributed 

to the production of a culturally and linguistically acceptable mass media intervention for 

Hispanic/Latino teens. 

Even if the language of the specific population 

is English, members of that population may 

have unique ways of speaking, or may use 

jargon or slang, so it’s always important to test 

the materials among audience representatives 

to ensure that communication is as clear and 

effective as possible. 

Materials development should also be guided 

by the use of appropriate and salient imagery. 

Positive imagery generally reflects a constructive visual of the target audience that is 

appropriate for the theme of the campaign. 

For example, an ad showing family members 

supporting a smoker’s attempt to quit may be 

effective among the Hispanic/Latino community where close family ties are a priority. 

Salient imagery reflects visuals that are particularly important to a target audience, helping 

attract audience members’ attention to the 

materials. For example, materials that 

integrate a rainbow image, which has been 

used by the GLBT community as an identifier 

and symbol of pride, could appeal to members 

of that community. 

Identifying and Addressing Potential 

Audience Barriers 

When developing your counter-marketing 

programs for specific populations, you may 

need to address existing audience barriers, 

such as historical mistrust of research; a resistance to targeted programs or efforts; and 

potentially positive perceptions of the tobacco 

industry, based on tobacco industry funding of 

Chapter 4: Reaching Specific Populations 103 
community organizations and events. In 

addition, some racial and ethnic communities 

are extremely sensitive about how their image 

has been portrayed in the media. For example, 

many African Americans are concerned about 

the mass media overrepresentation of AfricanAmerican drug use. Such experiences of 

specific populations could produce negative 

perceptions about the integrity of targeted 

programs or strategies. 

If you identify audience barriers in a specific 

population in your state, it is important that 

you address them. One way you can work to 

overcome these issues is by including the 

population in the campaign development 

process. You should work with their 

community leaders to communicate the value 

of your program. You must also be open and 

responsive to questions and concerns. For 

example, some recent immigrants may be 

reluctant to go to an unknown facility to 

participate in research or access health 

Checklist for Identifying and Overcoming Audience Barriers 

❑	 Use formative research to identify issues, including barriers that arise from concerns of 

the target group. 

❑	 Use target group representatives and community partners to help define and address 

audience barriers. 

❑	 When possible, develop strategies for overcoming barriers, including offering benefits 

that have value to the specific population. 

104 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

services because they fear that they could be 

turned in to the U.S. Immigration and 

Naturalization Service or because of negative 

experiences in their former countries. In a case 

like this, you might conduct research or 

provide health services in more familiar and 

comfortable locations. You could also enlist 

credible local spokespeople to build trust in 

the institutions and the facilities. 

Chapter 4: Reaching Specific Populations 105 
Case Study: California Smokers’ Helpline (1998) 

Background. The California Department of Health Services (CDHS) initiated a comprehensive tobacco 

control program in 1989 that was funded by revenue from an excise tax on tobacco. The main goal of the 

program was to reduce illness and mortality among smokers and nonsmokers caused by tobacco use. 

The program’s strategies included exposing the truth about tobacco industry practices and products, 

educating Californians about the harmful effects of smoking and secondhand smoke, and providing 

services and support to people who wanted to quit smoking. 

Developing cultural competence. The state of California has a diverse mix of residents. The CDHS 

tobacco control program staff needed to understand the composition of the population and why specific 

populations were important for reducing tobacco use. The tobacco control staff didn’t simply rely on their 

own knowledge; they hired outside experts to teach them about the specific populations in California. 

They made it a priority to embrace the racial/ethnic diversity in their state. They knew that a “general 

population” program would not meet the needs of all groups because of language and culture differences. 

Identifying and describing specific populations. Once the program staff decided to reach specific 

populations in California, they needed to determine some critical information: 

1. 	 The percentage of California’s population that was made up of Asians/Pacific Islanders, 

Hispanics/Latinos, African Americans, and other major specific populations, and whether those 

groups were increasing in numbers 

2. 	 The major subpopulations within each of those large groups and the important differences among 

subgroups in areas such as language and culture 

3. 	 The absolute levels of tobacco use in each specific population and trends in tobacco use 

4. 	 How, when, and with whom tobacco was being used, and what factors were influencing each group 

to smoke more or to smoke less 

Again, experts were hired to work with the staff to gather information in these four areas. Asians/Pacific 

Islanders were identified as an important specific population because of their large numbers within 

California and high population growth over the previous several years. The state tobacco control staff 

learned that Asians/Pacific Islanders included people from China, Japan, Korea, Laos, Singapore, and 

Vietnam, so they knew they could not communicate with all these populations in the same way. They 

also learned that Asian/Pacific Islander men had very high rates of smoking (up to 70 percent) and that 

they typically smoked in front of family members and friends when at home or socializing. The prevalence of smoking for Asian/Pacific Islander women was typically far lower (less than 10 percent), but 

they were an important secondary audience in terms of potential influence on their smoking husbands, 

brothers, or fathers. Thus, the tobacco control staff identified one primary audience (Asian/Pacific 

106 Chapter 4: Reaching Specific Populations 
Designing and Implementing an Effective Tobacco Counter-Marketing Campaign 

Islander male smokers) to target for reducing smoking when around others for cessation, and one secondary audience (Asian/Pacific Islander female nonsmokers) to target for influencing the male smokers in 

their families. The staff also decided to communicate the main messages of the campaign in the four major 

Asian languages of the Asian/Pacific Islander population (Cantonese, Korean, Mandarin, and Vietnamese). 

Conducting research. The first ads that were developed simply suggested that Asian/Pacific Islander 

smokers call the Quitline to get help from a counselor. The message was similar to the message for 

California’s general population, but the ads for Asians/Pacific Islanders were developed using Asian 

talent. Awareness of, and calls to, the Quitline remained low, even though the ads and the Quitline 

were in the four Asian languages. 

The CDHS tobacco control staff worked with its advertising agency to plan and conduct qualitative 

research to glean insights about why initial efforts were not working and what they could do to generate 

more calls to the Quitline. Research included interviews with smokers, as well as analysis of existing 

Quitline operations and promotions, to determine factors contributing to the low volume of calls. One 

important insight they uncovered was that in Asian culture, particularly among men, calling a counselor 

to ask for help was seen as a sign of weakness or an admission that the caller had a problem. 

Developing and implementing the campaign. Based on the research findings, the Quitline was repositioned as a source for free information on how to quit smoking, rather than a counseling service. The 

new campaign included several elements. The “Jungle” campaign featured radio and print advertising 

that dramatized how smokers feel when they try to quit smoking: lost, trapped, hopeless, and unable to 

break free from their addiction to cigarettes. The ads encouraged smokers to call the toll-free number to 

obtain free information on ways to quit smoking. 

A three-minute television ad, which was developed and aired in the four key languages, demonstrated 

for viewers what happens when someone calls the Quitline. The ad showed that the operator would be 

helpful, respectful, patient, and understanding. 

In addition, an advertorial (advertisement in a format that resembles editorial content) in key print 

publications discussed step by step how the Quitline operates and emphasized that it was a free 

resource. The article featured quotes from the Asian-language Quitline staff discussing the benefits of 

calling. Print ads, radio ads, and advertorials were all produced in Cantonese, Korean, Mandarin, and 

Vietnamese and were placed in the appropriate media outlets. 

Within two months of the campaign launch, the Asian-language Quitline received nearly 1,100 calls— 

more than all previous years combined, and a 10,000 percent increase over the previous year. Ad 

placements had to be suspended temporarily because the Quitline exceeded its capacity. Today, the 

Quitline receives a steady stream of phone calls each month because the advertising content and 

placement have been optimized over time. 

Chapter 4: Reaching Specific Populations 107 
Bibliography 

Centers for Disease Control and Prevention. Prevention Marketing Initiative Nashville Demonstration Site. 

“Reality Check”: A Teen-Oriented Radio Soap Opera. Nashville, TN: CDC, 1997. 

National Center for Cultural Competence. The Journey Towards Cultural Competence—The Wisconsin Story. 

Washington, DC: Georgetown University Center for Child and Human Development, 1999. 

Ryan H, Wortley PM, Easton A, et al. Smoking among lesbians, gays, and bisexuals: a review of the literature. 

American Journal of Preventive Medicine 2001;21:142–9. 

U.S. Department of Health and Human Services. Guidelines to Help Assess Cultural Competence in Program 

Design, Application, and Management. Bethesda, MD: USDHHS, Health Resources and Services 

Administration, Bureau of Primary Health Care, Office on Minority and Women’s Health, 1996. 

108 Chapter 4: Reaching Specific Populations